Standardisation of ready-to-use intravenous antimicrobial preparation in a paediatric hospital-at-home unit.

Costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home units in Spain

• Although administration of OPAT at home is now common practice, there is a paucity of data on the frequency of emergency department (ED) visits during such treatment. • The purpose of this study was to describe ED visits while on OPAT at home among patients discharged from a tertiary care hospital. Introduction • OPAT courses at Cleveland Clinic were identified from the institution’s OPAT registry which includes all patients discharged from hospital on parenteral antimicrobials. • All OPAT courses for patients discharged from hospital from January 1, 2013 to January 1, 2014, and treated at home, were selected. • For each treatment course ED visits that occurred while on OPAT were sought in the electronic medical record. Methods The majority of ED visits for patients on OPAT at home are unrelated to OPAT. About one in 20 patients receiving OPAT at home has at least one ED visit for an OPAT-related complication during the course of treatment, and about a fourth of these ED visits result in hospitalization. Conclusions • From January 1, 2013 to January 1, 2014, of 3161 OPAT courses at Cleveland Clinic, 1941 courses (61%) were administered at home for 1461 patients. • The total number of OPAT days for these 1941 courses was 43787. The baseline characteristics of the home OPAT courses are outlined in Table 1. • The distribution of reasons for ED visits is shown in Figure 1. • Of 297 ED visits, 115 (28%) were for OPAT-related complications (2.63 visits per 1000 OPAT days). Of the 115 OPAT-related ED visits, 17 (15%) were for antimicrobial adverse events (0.39 per 1000 OPAT days) and 98 (85%) for vascular access complications (2.24 per 1000 OPAT days). • 98 (5%) OPAT courses had at least one ED visit for an OPAT-related problem, with a median time to first visit of 9 days after hospital discharge. Results Baseline Characteristics Characteristic Age in years, mean ± SD Inpatient OPAT starts, n (% of OPATs) Vascular access device, n (% of OPATs) PICC Hohn catheter Tunneled central venous catheter Tunneled dialysis catheter Dialysis fistula or graft Indwelling port Midline Peripheral catheter Non-tunneled central venous catheter Active injection drug use Cleveland Clinic Home Infusion Pharmacy, n (%) Cleveland Clinic at Home Nursing, n (%) OPAT duration in days, mean (SD) Frequency 55 ± 15 1682 (87) 1508 (78) 152 (8) 142 (7) 18 (<1) 7 (<1) 95 (5) 15 (<1) 1 (<1) 3 (<1) 16 (0.8) 901 (46) 811 (42) 23 (17) 24% 4% 72% Antimicrobial Adverse Event Vascular Access Complication Unrelated to OPAT Figure 1. Reasons for ED Visits Table 1 Characteristic Vascular Access complication (n = 98) Admit to hospital, n (%) 20 (20) Days after OPAT start, median (Q1, Q3) 11 (5, 19) Antimicrobial Adverse Event (n = 17) 5 (29) 5 (3, 11) Unrelated to OPAT (n = 182) 84 (46) 8 (3, 14) Table 2. Characteristics of ED Visits by Reason for Visit ED Visits

BackgroundOutpatient parenteral antimicrobial therapy (OPAT) offers an alternative to inpatient (hospital bed-based) treatment of infections that require intravenous administration of antimicrobials. This meta-analysis aimed to summarise the evidence available from randomised controlled trials (RCTs) regarding the efficacy and safety of OPAT compared to inpatient parenteral antimicrobial therapy. MethodsWe searched the Cochrane Library, MEDLINE, Embase, PubMed, and Web of Sciences databases for RCTs comparing outpatient versus inpatient parenteral antimicrobial therapy. We included studies without restrictions on language or publication year. Eligibility was reviewed independently by two assessors, and data extraction was cross validated. We evaluated bias risk via the Cochrane tool and determined the evidence certainty using GRADE. Meta-analysis was conducted using a random effects model. The protocol of this review was registered on PROSPERO (CRD42023460389). ResultThirteen RCTs, involving 1,310 participants were included. We found no difference in mortality (Risk Ratio [RR] 0.54, 95% Confidence Interval [CI] 0.23 to 1.26; P = 0.93), treatment failure (RR 1.0, CI 0.59 to 1.72; P = 0.99), adverse reaction related to antimicrobials (RR 0.89, CI 0.69 to 1.15; P = 0.38), and administration device (RR 0.58, CI 0.17 to 1.98; P = 0.87) between outpatient and inpatient parenteral antimicrobial therapy. The overall body of evidence had a low level of certainty. ConclusionExisting evidence suggests OPAT is a safe and effective alternative to inpatient treatment. Further RCTs are warranted for a thorough comparison of inpatient and outpatient parenteral antimicrobial therapy with a high level of certainty.

IntroductionCeftobiprole medocaril is a new fifth-generation cephalosporin commercially available as a prodrug. Since it is newly introduced in therapy, there is limited data on its physicochemical stability for outpatient parenteral antimicrobial therapy (OPAT). This work aimed to demonstrate the suitability of ceftobiprole medocaril in OPAT, determining the physicochemical stability within portable elastomeric infusion devices (Accufuser C0100L 10 mL/h 300 mL).MethodsPhysicochemical stability was evaluated in 6.25 mg/mL solutions in sodium chloride 0.9% and dextrose 5% at three temperatures (2–8 °C, 25 °C, and 32 °C) using a previously validated liquid chromatography triple quadrupole mass spectrometry (LC-QQQ-MS) method. Drug adsorption onto device walls was also determined at the end of the study.ResultsCeftobiprole medocaril remained above 95% of the initial concentration in sodium chloride 0.9% for up to 24 h at both refrigerated (2–8 °C) and ambient conditions (25 °C). Stability was reduced in dextrose 5% solutions. While pH increased slightly over time, it remained within acceptable limits for intravenous administration, and no particle formation was detected. Drug adsorption to the elastomeric device was negligible (< 0.1%).ConclusionCeftobiprole medocaril is suitable for administration in OPAT at 6.25 mg/mL in sodium chloride 0.9% over 24 h at 25 °C using Accufuser® portable elastomeric infusion devices. These findings support the development of practical administration protocols for ceftobiprole medocaril in home-based antimicrobial therapy.Plain Language SummaryCeftobiprole medocaril is a new antibiotic used to treat serious infections. Because it was recently introduced, there is limited information about its stability when used for outpatient parenteral antimicrobial therapy (OPAT), a treatment that allows patients to receive intravenous antibiotics at home using portable elastomeric infusion devices. This study examined how stable ceftobiprole medocaril remains when stored and administered in portable elastomeric infusion devices. The antibiotic was diluted in two commonly used fluids (saline and dextrose) and kept at different temperatures: refrigerated (2–8 °C), room temperature (25 °C), and body temperature (32 °C). Researchers measured how much of the drug remained active over 24 hours and whether it adhered to the inside of the device. The results showed that ceftobiprole medocaril in saline solution (sodium chloride 0.9%) remained stable for 24 hours at room temperature and when refrigerated, keeping over 95% of its original amount. In dextrose, the drug was less stable. The pH changed slightly, but no harmful particles formed, and less than 0.1% of the drug stuck to the infusion device, confirming that the device is suitable for this use. On the basis of these findings, ceftobiprole medocaril can be safely administered in saline solution over 24 hours at room temperature using portable infusion devices. This helps support safe and effective use of the antibiotic in OPAT settings.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-025-01174-7.

Background Outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective service to manage infections in patients.1 OPAT allows medical admission avoidance for stable patients and allows for early discharge for patients with ongoing IV antimicrobial therapy needs. OPAT therefore allows the optimization of hospital bed management and relieve pressures on the NHS.2 The primary aim of this audit is to determine the number of bed days saved in secondary care through early discharge and admission avoidance by the OPAT service which is completed by Cornwall Foundation Trust’s Acute Care at Home (ACAH) Team. This study did not require ethics approval. Objectives (i) To quantify the total number of bed days saved by referral to OPAT; (ii) to determine the total number of days of each IV antibiotic received by patients under the OPAT service and (iii) to compare treatment course lengths for infections being managed by the OPAT service against nationally reported data. Standards 100% of patients must be receiving IV antibiotics with an indication whilst under OPAT. 100% of patients must have an IV antibiotic dose, frequency and administration method documented. 100% of patients must have an acceptance date by the OPAT team. Methods Patients were identified from daily handover documents from the ACAH team for the period of 1 February to 28 February 2023. Data collection was obtained using the clinical recording and electronic health recording system, RiO and Maxims, and the electronic prescribing and medicine administration (EPMA) system. The number of bed days saved is calculated from the acceptance date to OPAT to the discharge date from OPAT for each patient. Results A total of 70 patients were captured during initial data gathering, of which 41 patients met the inclusion criteria for the audit. Of these 41 patients meeting the audit criteria, 21 (51.2%) patients were referred from primary care and 20 (48.9%) patients were referred from RCHT. The total sum of bed days saved was 343 days, and the total sum of OPAT treatment days was 302 days. The most prescribed antibiotic was Ceftriaxone, with 27 patients (%) receiving this antibiotic; other antibiotics included the following: Tazocin (n = 5), ertapenem (n = 5), flucloxacillin (n = 2), gentamicin (n = 1), meropenem (n = 1) and teicoplanin (n = 1). The recorded indications were recorded, and when compared with the average treatment duration for each infection type against the NORS 2015–2020 data,3 the average treatment days in this audit were within range. Conclusions These results demonstrate that the OPAT service utilized by RCHT has a significant impact on bed utilization, through reducing hospital admissions and facilitating early discharge. Course lengths are in keeping with the national reported average indicating that patients are receiving comparable course lengths to other OPAT providers; further work to compare these course lengths against national best practice would be useful. There are limitations to the results, as the number of bed days saved was capped to the end of the audit data collection period. Recommendation to improve would be to re-audit with a longer data collection time frame.

BackgroundProviding a safe discharge in patients appropriate for outpatient parenteral antimicrobial therapy (OPAT) became an important focus of the inpatient to outpatient transition during the pandemic. Hospital beds were needed for ill patients with COVID; transfers in and out of facilities and interfacility infection became issues for long-term care (LTCF) and short-term nursing facilities (SNFs) in the US during the pandemic. We examine the traditional barriers, including age, and outcomes of patients selected for OPAT initiation during the pandemic period.MethodsWashington DC VAMC (WDVAMC) is an urban medical center with 220 acute and LTC beds. At the start of the pandemic, a multidisciplinary OPAT program was initiated and led by ASP Nurse Practitioner (NP), supported by ASP Pharmacist and ASP/ID Physician. OPAT included care continued at home, SNF, LTC and hemodialysis locations; the OPAT program focus was on appropriate selection, post-discharge safety monitoring, outpatient follow-up at completion, tracking and outcome determination (30D, 90D readmissions). OPAT related readmissions related to drug or opat-indicated infections.ResultsBetween April 2020-2022, 157 unique OPAT discharges (10.4 OPAT/1,000 admissions 2020 and 4.8 OPAT/1,000 admissions 2021); the majority were offered OPAT at home (47%). Mean duration OPAT 22±13days over that period; most frequent indication osteomyelitis and BSI. OPAT related readmissions were infrequent at 30D (7%) and 90D (1%). The mean age was 67±13y with 5% >90yrs, 21% >75yrs and 58% >65yrs. In the pandemic 92% completed OPAT; compared to younger group those >75y, rates of completion (93% vs 92%, P=NS) and mean duration of OPAT were similar however a modest increase in 90D OPAT-related readmission (1.2% vs 0%, P=0.04). The only two deaths prior to completion of OPAT occurred in those >75y.ConclusionTransitions to OPAT are required for serious infections in hospitalized patients of all ages, however transitions to SNF and LTC were limited at times during the pandemic. We found OPAT can be delivered safely, regardless of age during a pandemic state with careful coordination between stakeholders and a systematic process to monitor outcomes and track patients, particularly for the elderly.DisclosuresAll Authors: No reported disclosures.

Background At the Michael E. DeBakey Veterans Affairs Medical Center, an interdisciplinary outpatient parenteral antimicrobial therapy (OPAT) clinic was developed in August 2020 during the COVID-19 pandemic (Figure 1). Standardized weekly safety monitoring and clinical follow-up was implemented via tele-OPAT visits by an infectious diseases (ID) pharmacist or ID PA with ID physician oversight. This study aimed to describe the practices implemented through initiation of our OPAT clinic, and its impact on clinical outcomes. Figure 1:Description of intervention and clinic model Methods This retrospective cohort study compared clinical outcomes of veterans receiving home OPAT one year pre- and post-implementation of a dedicated OPAT clinic. OPAT episodes initiated during the intervention period, prescribed for less than 7 days, not completed at time of analysis, administered with hospice services, or at a hemodialysis center, infusion suite, skilled nursing facility or long-term care facility were excluded. The primary endpoint was treatment failure during or within 30 days of OPAT completion defined as requiring repeat OPAT course for the same infection, unplanned admission, unplanned surgical intervention or procedure for additional source control, or death from any cause. Results A total of 191 OPAT episodes were included in the analysis (pre-intervention group, n= 76 vs. post-intervention, n=115). The most common indications for OPAT included bone/joint infections (34%), bacteremia (24%), and endocarditis (13%). Treatment failure was lower in the post-intervention vs. pre-intervention group (29% vs 46%, p = 0.01) with a median time to treatment failure of 24 days. Treatment failures in both groups were primarily driven by unplanned hospital admissions (Table 3). The median time to ID follow-up from OPAT initiation was shorter in the post-intervention vs. pre-intervention arms (6 days vs. 9 days, p&amp;lt; 0.001). The adverse event rate was higher (13% vs. 4%, p= 0.06), and modifications were made more frequently in the post-intervention (49% vs. 29%, p=0.007). Table 1:Demographics and baseline characteristicsTable 2:OPAT indications, antimicrobials, and microbiologyTable 3:OPAT follow-up, complications, and treatment failure Conclusion Implementation of an interdisciplinary OPAT clinic led to shorter time to ID follow-up, more frequent OPAT modifications, and reduced treatment failure. The median time to treatment failure suggests the need for ongoing surveillance beyond the initial 2 weeks of OPAT. Disclosures All Authors: No reported disclosures.

Laboratory tests are usually requested for monitoring during outpatient parenteral antimicrobial therapy (OPAT), but these recommendations are not always followed. The purpose of this study was to determine whether rehospitalization during the OPAT course is associated with the availability of these test results to the treating physician. Electronic health records (EHRs) from all patients in the Cleveland Clinic OPAT registry with start dates from 1 January to 28 February 2011 were reviewed in a retrospective cohort study. Comprehensive data on patient and OPAT characteristics were obtained for the first OPAT course per patient. Availability of laboratory test results was defined as documentation of results of at least one recommended test in the health system's EHR. Proportions of patients rehospitalized were compared for OPAT courses with test results available and non-available. Adjustments were made for patient age, hospital length of stay, anticipated OPAT duration, OPAT site and Charlson comorbidity index score. Four hundred patients received OPAT during the study period; 60% at home, 36% in skilled nursing facilities or long-term acute care facilities and 4% in other settings. Recommended monitoring laboratory test results were available to infectious disease physicians in 291 (73%) OPAT episodes. There were 82 patient readmissions (21%) while on OPAT. In a multivariable logistic regression model, non-availability of recommended test results was independently associated with readmissions while on OPAT (adjusted OR 2.53; 95% CI 1.36-4.73). Non-availability of recommended test results to treating physicians for patients on OPAT is associated with increased readmissions during OPAT.

Background: Variability in outpatient parenteral antimicrobial therapy (OPAT) management and challenges to providing recommended OPAT care can compromise patient safety and care quality. Little is known about how OPAT is currently delivered by healthcare systems across the United States (US), including within the Veteran’s Health Administration (VHA). We sought to understand and compare OPAT delivery at selected Veterans Affairs medical centers. Method: Using a qualitative methodology, we conducted semi-structured interviews with key informants involved in OPAT delivery at 6 VHA medical centers with different complexity levels in the Midwestern US. Facility complexity is determined by patient volume and complexity level along with the amount of teaching and research conducted at the facility. Interviews occurred between February and December 2024 with healthcare personnel (n=30), including primary care and infectious diseases physicians, pharmacists, nursing staff, care coordinators, and vascular access providers. Data collection focused on better understanding OPAT processes within key domains of decision-making, patient education, care coordination, and post-discharge management. We used rapid analysis and a summary matrix to compare practices across sites within each domain. Result: Our findings highlight significant variability among VHA medical centers that provide OPAT to Veteran patients. Three of the 6 medical centers had dedicated OPAT programs as evidenced by a multidisciplinary team with clearly delineated roles and responsibilities, and processes that may help mitigate adverse outcomes and improve communication between providers at all OPAT care points. These processes map to the key elements outlined in the Infectious Diseases Society of America (IDSA) practice guidelines for OPAT programs, and include determination of appropriate therapy, patient education, lab monitoring, and discontinuation of treatment. (Figure 1) Conversely, at the three VHA sites without evidence of a multidisciplinary OPAT team or program, most participants described poor communication and coordination, lack of support, and uncertainty among providers about who is responsible for OPAT care. This confusion extends to follow-up and discontinuation of treatment. OPAT key elements were lacking or poorly defined. A process map helps visualize the contrasts in care between sites with and without defined OPAT programs. (Figure 1) Conclusion: Despite its centralized healthcare system, VHA medical centers demonstrate highly variable processes with respect to OPAT care. In the absence of a clear OPAT policy or program, uncertainty among providers about roles and responsibilities may be greater. The presence of a dedicated multidisciplinary OPAT team may help improve communication and care coordination, thereby minimizing quality and safety concerns.

Background: Patients in the 65+ age group and those receiving outpatient parenteral antimicrobial therapy (OPAT) in the home setting are increasing. There is a void in research that investigates OPAT satisfaction and outcomes in the 65+ age group. To better serve the home infusion needs of this population, an investigation of the patient’s OPAT success rate and understanding of home infusion instructions is needed. The purpose of this study is to determine if differences exist between OPAT patients aged 18-64 and 65+ in their understanding of home infusion instructions and their therapy success rate. Methodology: Study data was obtained from the National Home Infusion Foundation (NHIF) database, including data from the NHIF-validated patient satisfaction survey and status at discharge benchmarking project. Five questions about the patient’s understanding of instructions are part of the satisfaction survey. Status at discharge data was used to determine OPAT success since therapy completed, unplanned hospitalizations, and adverse drug reaction (ADR) data were collected. Data analysis included determining if a significant difference (p= ≤ .05) exists between the 18-64 and 65+ age groups. Results: Forty-five home infusion providers submitted 3,262 OPAT patient satisfaction surveys, while 15 submitted 4,360 OPAT status at discharge patient cases to the NHIF database. The composite score for the 5 Yes/No questions that assessed the patient’s understanding of instructions was 98.45%. The only significant difference detected by the Fisher’s Exact Test between the 2 age groups was the response to the question about the patients’ understanding of how to wash their hands. “Therapy completed” status at discharge from home infusion accounted for 90.11% of the OPAT 65+ year old patients. The rate of ADRs in the 65+ patient population was 0.25%, while the 18-64 age group rate was higher at 0.42%. Conversely, the unplanned hospitalization rate was higher in the 65+ age group (4.79%) than in the 18-64 age group (3.28%). The results of the Chi-Square analysis indicate a significant difference (p=.027) between the 2 age groups and status at discharge. Discussion: The patient-reported data collected by NHIF reveals a significant difference (p=.009) between the 18-64 age group and older adult (65+) in their understanding of how to wash their hands with the 18-64 age group having a better understanding of the task. When calculated as a composite score, 98.45% of older adults report understanding the instructions provided on how to wash their hands, store medications, care for the IV catheter, administer the IV therapy, and use the equipment. Significant differences exist (p=.027) in the status at discharge between adults 65+ and those 18-64. Older adults are less likely to have an ADR but are more likely to be discharged from home infusion due to an unplanned hospitalization. This difference can be attributed to the higher clinical acuity and co-morbidities associated with increased age. Even so, 90.11% of the patients age 65+ successfully completed OPAT therapy. Conclusions: An aging population in the U.S. is driving increased use of home-based OPAT in adults 65+. This study confirms that most older adults understand the instructions related to performing home infusion tasks. While over 90% of older adults in this study were successful in completing their home-based OPAT therapy and had a lower rate of ADRs, there was a significant difference in patients 65+ when compared to patients 18-64 years of age in the reasons for discontinuing home-based OPAT, including higher rates of unplanned hospitalization. Keywords: Home infusion, outpatient parenteral antimicrobial therapy (OPAT), 65+, patient instructions, adverse drug reaction (ADR), therapy complete, unplanned hospitalization

Background Outpatient parenteral antimicrobial therapy (OPAT) practice has continued to increase. We sought to understand current OPAT practices in a survey of U. S. clinicians.Figure 1Respondents rated their agreement with the following statement: “The OPAT program at my hospital receives adequate support in the following areas”Figure 2Factors present in providing safe OPAT services on a scale where 1 is “extremely challenging” and 5 is “not challenging at all” Methods A survey instrument was developed by ID physicians, pharmacists and Infectious Diseases Society of America (IDSA) Emerging Infections Network (EIN) staff, utilizing prior EIN OPAT surveys. The survey focused on respondents’ role, responsibilities, time devoted to OPAT, structure of OPAT provision, location where OPAT is received, institutional support and oversight, role of complex outpatient antimicrobial therapy (COpAT) including oral antimicrobials and long-acting injectable agents, and barriers to safe OPAT care. The confidential survey was distributed to adult EIN members from Feb to March 2025. Results Overall, 622 (38%) EIN members responded to the survey, of whom 469 with a role in managing OPAT patients were eligible to complete the survey. OPAT teams varied across programs with nearly all involving ID physicians (98%), majority involving ID/OPAT pharmacists (61%), nurses (60%), and nearly half involving administrative staff (48%) and advanced practice providers (APPs, 47%). ID consultation for OPAT enrollment was required in 60% of programs. Many programs (59%) report including COpAT. Response to outpatient lab results was largely managed by ID physicians (75%); however, multidisciplinary OPAT teams (37%), pharmacists (33%), and inpatient ID physicians (30%) were also frequently involved. Lab values were most often available via fax/email (43%) or electronic health record (EHR, 41%). Nearly 25% of programs “often/always” required proactive outreach to obtain safety labs. Overall, many programs lacked data analysis, administrative, information technology, and financial support (Figure 1). Challenges faced by OPAT programs included lack of leadership awareness of the value of OPAT (51%), difficulty managing patients with substance use disorder (50%), access to timely lab values (48%), personnel to retrieve missing lab values (46%), and struggles with the EHR (43%) (Figure 2). Conclusion Compared to EIN OPAT surveys in 2013 and 2019, programs have grown in size and composition, and expanded to COpAT. Similar problems persist regarding perceived lack of support. Disclosures Monica V. Mahoney, PharmD, BCPS, BCIDP, FCCP, FIDSA, FIDP, FMSHP, gsk: Advisor/Consultant|seqirus: Advisor/Consultant Philip M. Polgreen, MD, Eli Lily: Advisor/Consultant|Pfizer: Grant/Research Support Sara C. Keller, MD, MPH, MSPH, CorMedix: Grant/Research Support

Background Outpatient parenteral antimicrobial therapy (OPAT) refers to the delivery of parenteral antimicrobial treatment in at least two doses on different days without hospitalization required. Implemented antimicrobial stewardship programs (ASP) have reported significant reductions in unnecessary antibiotic prescriptions and improved patient outcomes. At the Salisbury Veterans Affairs Health Care System (SVAHCS), the OPAT program enrolls approximately 150 Veterans annually to which 86% of OPAT requests originate outside of VA care. The purpose of this study was to evaluate the efficacy and safety of OPAT along with ASP practices at SVAHCS.Clinical Characteristics and Most Common OPAT AntimicrobialsOPAT Indications Methods This quality improvement project was conducted as a retrospective cohort study on eligible Veterans on OPAT between January 2022 through December 2024. The main objective was to assess the efficacy of OPAT. The primary outcome was readmission rates to a hospital while receiving OPAT due to complications, adverse events, treatment failure or for reasons unrelated to infection or OPAT regimen. Secondary objectives included evaluating safety, 30-day mortality post-OPAT, 30-day readmissions post-OPAT, rate of OPAT completion, the reduction of hospital bed days of care (BDOC) and intravenous (IV) line days avoided, ASP interventions and potential cost savings.PAT Readmissions during OPAT and Associated ReasonsOPAT ASP Interventions and Potential Cost Savings Results A total of 398 Veterans were included in this study with 53 (13%) readmissions during OPAT. Of those readmissions, 15 (28%) were secondary to antibiotic failure, 11 (21%) were due to adverse effects and 27 (51%) for concomitant diseases. There were five deaths which equates to a post-OPAT 30-day mortality rate of 1%. Nine readmissions (2%) occurred within 30 days post-OPAT with 2 (22%) due to antibiotic failure, 1 (12%) secondary to adverse effect and 6 (66%) for concomitant diseases. The OPAT completion rate was 97%. A mean of 3,337 BDOC and 134 IV line days were avoided annually. A total of 4,575 ASP interventions associated to OPAT were documented with potential cost savings of $611,669. Conclusion The OPAT program and ASP at SVAHCS effectively manage Veterans with low 30-day mortality and adverse effect rates, high OPAT completion rate and comparable readmission rates to current literature while diligently implementing ASP interventions with associated potential cost savings. Disclosures All Authors: No reported disclosures

Outpatient parenteral antimicrobial therapy (OPAT) is a safe and cost-effective transitional care approach administered via different delivery models. No standards exist for appropriate OPAT program staffing. We examined outcomes of patients receiving OPAT via different care models to identify strategies to improve safety while reducing health care overuse. Retrospective demographic, clinical, and outcome data of patients discharged with OPAT were reviewed in 2 periods (April-June 2021 and January-March 2022; ie, when staffing changed) and stratified by care model: self-administered OPAT, health care OPAT, and skilled nursing facility OPAT. Of 342 patients, 186 (54%) received OPAT in 2021 and 156 (46%) in 2022. Hospital length of stay rose from 12.4 days to 14.3 in 2022. In a Cox proportional hazards regression model, visits to the emergency department (ED) within 30 days of OPAT initiation (hazard ratio, 1.76; 95% CI, 1.13-2.73; P = .01) and readmissions (hazard ratio, 2.34; 95% CI, 1.22-4.49; P = .01) increased in 2022 vs 2021, corresponding to decreases in OPAT team staffing. Higher readmissions in the 2022 cohort were for reasons unrelated to OPAT (P = .01) while readmissions related to OPAT did not increase (P = .08). In a well-established OPAT program, greater health care utilization-length of stay, ED visits, and readmissions-were seen during periods of higher staff turnover and attrition. Rather than blunt metrics such as ED visits and readmissions, which are influenced by multiple factors besides OPAT, our findings suggest the need to develop OPAT-specific outcome measures as a quality assessment tool and to establish optimal OPAT program staffing ratios.

Background Outpatient parenteral antimicrobial therapy (OPAT) has many potential benefits, including avoidance of hospitalizations, reduced length of stay, and prevention of hospital-associated conditions. However, suboptimal OPAT delivery can result in readmissions and emergency department (ED) visits—outcomes that are unfavorable for patients and disincentivized within value-based care (VBC) models. Structured OPAT programs have been shown to decrease unscheduled healthcare use. Total cost of care (TCOC) analyses for OPAT program justification have not been well described. We therefore analyzed TCOC for a cohort of OPAT recipients enrolled in VBC pre- and post-implementation of OPAT plan reconciliation in June 2020. Methods Unique, adult OPAT patients discharged to home or post-acute care facilities from an academic hospital between 6/2019 and 6/2022 were included. Infectious diseases (ID) pharmacist reconciliation of OPAT plans prior to hospital discharge launched on 6/14/2020; all OPAT recipients discharged on or after this date were included in the post-implementation cohort. Average one-year post-intervention TCOC avoidance per patient was calculated using patient charges, a proxy for payor cost. The percentage of patients enrolled in a VBC plan was determined to calculate implied TCOC reduction annually. Results Nine hundred sixty-two OPAT patients were included: 198 pre- and 764 post-implementation. Fewer patients were included in the pre-intervention group given unretrievable financial data due to archiving rules. In our cohort, 16.9% of patients were enrolled in a VBC plan. Both pre- and post-intervention cohorts showed an increase in TCOC after index OPAT hospitalization; pre-intervention at 155% and post at 29%. This yielded a post-intervention average one-year cost avoidance of $15,754.55/patient. Based on our institution’s historical OPAT volume of 950 patients cared for annually, these data equate to an implied TCOC reduction of $2,529,409/year. Conclusion Implementation of formal ID pharmacist reconciliation of OPAT plans generated significant cost avoidance amongst OPAT patients enrolled in VBC plans. This is evidence that outcomes incentivized by VBC models align with outcomes facilitated by structured OPAT programs. Disclosures Jennifer Ross, PharmD, BCIDP, Shionogi Inc.: Advisor/Consultant Elizabeth B. Hirsch, PharmD, FCCP, FIDSA, GSK: Advisor/Consultant|GSK: Honoraria

BackgroundSuccessful management of outpatient parenteral antimicrobial therapy (OPAT) optimizes outcomes and reduces cost. We examined (i) local OPAT processes and outcomes, (ii) whether OPAT constraints favoring once daily antibiotics promoted suboptimal therapeutic choices, and (iii) whether these data could drive OPAT improvements.MethodsPatients ≥ 18 years of age who received > 48 hours of OPAT at five infusion centers within a single health-system from January 1, 2018 to March 1, 2018 were eligible for review. The following patient- and treatment-level data were collected: age, gender, drug allergies, laboratory studies and frequency, OPAT indication, infection source, pathogen(s), antibiotic sensitivities, antibiotic therapy and duration, electronic order set used, prescriber specialty, evidence of failed prior oral or intravenous (IV) therapy and IV access type. The primary outcome was OPAT success: the clinical resolution of the infection without relapse within 30 days of antibiotic therapy completion. Secondary outcomes included change in antibiotic therapy due to lack of clinical improvement, adverse drug reactions and IV access complications. A sub-analysis of patients who received daptomycin and/or ertapenem was also performed. OPAT practice was compared with 2018 Infectious Diseases Society of America OPAT guidelines (Norris et al. Clin Infect Dis. 2019;68(1):e1-e35).ResultsA total of 108 patients were evaluated. Patient demographics, treatment and outcomes are shown in Table 1. The most common OPAT indications were bone/joint, bacteremia and skin infection. Third-generation cephalosporins, carbapenems and daptomycin were most commonly prescribed. In 34.3% and 24.2% of daptomycin and ertapenem cases, respectively, β-lactam therapy could have been utilized. Assessment of prior failed antibiotic therapy, patient allergies and pathogen-site pairing found 28.7% of patients were eligible for oral therapy upon OPAT initiation.ConclusionSeveral components of our local OPAT aligned with current guidelines. Initial OPAT patient selection may benefit from added scrutiny. Given the high volume of once daily antibiotics administered for convenience there is an internal opportunity to facilitate multi-daily infusions.DisclosuresAll authors: No reported disclosures.